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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Robert C Ramundo
1ST 0 0 c ~
2ND 0 D 0 '1
3RD 0 0 0 c
COUNT,Qutchess
CITYiTOWNWappinger
~~~~kCR"1368
~~~'~J~F58
A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERS61 34-50-5545
D SOCIAL SECURITY NUMBER I
2 RESIDENCE ANew York B Oranqe
(STATE) J (COUNTY)
C CHECK ONE [J CITyrO TOWN [J VILLAGE
~~~CIFY Cornwall
o STREET ADDRESS P.O. Box 251 Route 32 ZIP 1 0953
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YEs"'O NO
/24 /1961
DAY YEAR
3 A
AGe1: 1
01
MONTH
3B. DATE OF BIRTH
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4 EMPLOYMENT
A. USUAL OCCUPATloNEngineer Technician
B TYPE OF INDUSTRY OR BUSINESJ. B. M.
5 PLACE OF BIRTH Yonkers. New York
(CITY, STATE/COUNTRY IF NOT USA)
6 FATHER
A. NAMEfrederick Ramundo
B COUNTRY OF BIRTJJ S A
7. MOTHER
A MAIDEN NAME Diana Brady
B COUNTRY OF BIRTH USA
NUMBER OF THIS MARRIAGE 1
9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C DATE LAST MARRIAGE ENDED?
(3) U ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES C NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DA TE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
;::
3:
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I
(THIS SPACE FOR STATE USE ONL Y)
{lint
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!J .' j?". tJq
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kathleen M. Wasilko
~
11 A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C SURNAME AFTER MARRIAGE Ramundo
(OPTIONAL' SEE REVERSEh73-66-3302
D SOCIAL SECURITY NUMBER U
12 RESIDENCE "New York BDutchess
(STATE) J-, (COUNTY)
C CHECK ONE 0 CITY U TOWN 0 VILLAGE
AND \AI .
SPECIF,.~applnqer
D STREET ADDRES!iO Scott Drive Z1P12590
i:J YES""'LJ NO
'J,g'66
YEAR
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13 A. AGF35 13.B. DATE OF BIRTH 09 113
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATIO$taff Accountant
B TYPE OF INDUSTRY OR BUSINES~ield Home - Holy
15 PLACE OF BIRTSrooklyn. New York .
(CITY. ST A TE:COUNTRY IF NOT USA)
16. FATHER
A NAMEThomas Wasi\ko
B COUNTRY OF BIRTW S A
17 MOTHER
A. MAIDEN NAMEJO Ann Sankevich
B COUNTRY OF BIRTlI S A
18 NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B HOW DID LAST MARRIAGE END? (3) i:J DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) i:J DEATH
MONTH DAY YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY. YEAR) (CITY. STATE COUNTRY. IF NOT USA) SELF SPOUSE
~\
U L
information I provided is true and that I declare that no legal ~mpediment exists
2 SIGNATURE OF BRIDE ~ ~~ (~ tkD
USE CURRENT NAME
DATE 05/13/2002
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York Stat of authorized by New York Domestic
Relations Law 911 to perform marriage ceremonies within w York State. THIS LICENSE VALID IN NEW YORK STATE ONLY,
o If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24 TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)..Glo .
TIME YEAR MONTH DAY
SEAL SIGNATURE ~ DATJJ5/13/2002
~ ~&'~faD e15ush Rd NY 12590
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
r..
29 OFFICIANT I-..:.)..[) . \ . I " r "
NAME (PRINT) . '\.Jv' \ I\\J~ I \ ~( TITLE
SIGNATURE~ 41), JI~lhd f~ ~1'\~0
AILlNGA'DDR~ ~ .
.(,). .~ ~ 2-~ l-k - -i\ \'c.l.." C ~\ on
STREET ITY.TOWN
30 WITNESS TO CEREMONY
21 SIGNATURE OF GROOM ~
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YEAR ~ELlGIOUS
6J- 9 [J OTHER. SPECIFY
25. B SOLEMNIZATION PERIOD
ENOS AT MIDNIGHT ON
YEAR
ZIP
2002 07
12 2002
STATE
27. TYPE OF CEREMONY
1:::J CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY n Lt kh, .::...
KC- t;-J' 't 5i
DATE 5 !cJ~-/od..
N (-/ l '2.~~~
TATE
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF A TOWN OF C VILLAGE OF
SPECIFY l::L"~5t- h~~. k; I)
NAME (PRINT)
SIGNATURE ~ ()